According to the Center for Disease Control and Prevention (CDC, n.d.), kidney diseases are the top ninth leading cause of death in the United States. Data from another source shows that nearly 750,000 patients in the United States are affected by kidney failure annually (United States Renal Data System [USRDS],2018). Also, there is an estimation that about 37 million adults have Chronic Kidney Disease (CKD), and most of them are undiagnosed. 40% of them are living with acutely reduced kidney function, but they are not aware of it. The leading causes of kidney failure were identified as diabetes and high blood pressure (3 out of 4 new cases) respectively (CDC, n.d.). End-stage renal disease (ESRD) is the last phase of chronic kidney disease. It is the continuous deterioration of the function of the kidney. Patients with this kidney condition require a regular course of dialysis or a kidney transplant to survive (Eggers, 2000). According to the United States Renal Data System (USRDS), 703,243 Americans were receiving treatment for ESRD in 2015, compared to 56,434 receiving treatment in 1980. This data indicates the alarming trend of increasing the ESRD. In 2018, 131,636 patients were newly treated for ESRD, and in 1980, 17,903 patients were newly treated. Though the rate of ESRD has declined since the 2010s, it is still the highest in the world (USRDS, 2020).
In terms of demographic distributions, men are more likely to develop ESRD than women. The proportion between males and females is 60:40 (CDC, 2019). Older adults aged 75 and older are the most vulnerable group having the highest prevalence of ESRD (1584.2 per million) (USRDS, 2020). Thus, as people age, they are more likely to develop ESRD. Among certain racial and ethnic groups, Native Hawaiians/Pacific Islanders, African Americans, and Hispanics have a higher prevalence of ESRD than whites in terms of the number of people being newly treated for ESRD within a set population. The African American and Latino American population are respectively 3.5 and 1.5 times more likely to have ESRD as compared to the white population (National Institute of Diabetes and Digestive and Kidney Diseases [NIH], 2016).
Importantly, Native Hawaiian and Asian American populations are the most understudied racial/ethnic groups in CKD and ESRD research. Existing data shows that ESRD is 9.5 times greater among the Native Hawaiian population and 1.3 times greater among the Asian American population than among the non-Hispanic white population (Kataoka-Yahiro et al., 2020). As Hawaii is one of the prominent U.S. states for having the maximum proportion of the Native Hawaiian and Asian American population, it is obvious for this state to have more ESRD prevalence compared to the other parts of the nation. Based on the latest data, the prevalence of ESRD in Hawaii is 2,315.2 patients per million people (USRDS, 2020). Also, over 25% of Medicare enrollees are diagnosed with chronic kidney disease, and 25.4% of these people are older than 65 years old (Hawaii Health Matters, 2017).
Since CKD and ESRD are the leading causes of death in the U.S., the costs of the treatment are also significant to consider for both national and local levels. Therefore, being enrolled in the Medicare program is beneficial for ESRD patients due to the coverage of these plans. In 2018, at the national level treating Medicare beneficiaries with CKD cost over $81.8 billion or $23,700 per person. The amount was $36.6 billion or $80,000 per person for treating people with ESRD. ESRD comprises 1% of the total Medicare beneficiaries but accounting for about 7% of the Medicare paid claims costs (CDC, n.d). Hemodialysis care costs the Medicare system an average of $90,000 per patient annually in the United States, for a total of $28 billion. Spending for transplant patient care is $3.4 billion (USRDS, 2020).
Thus, the way Medicare for the patient with ESRD and their treatment has been playing a crucial role since 1972 when congress enacted legislation allowing qualified individuals with ESRD under the age of 65 to enroll in the federal Medicare health care program (Kirchhoff, 2018). After this historical legal enactment, Medicare has become the primary source of health care coverage for individuals with ESRD across the nation. The concern is that 1.5% of beneficiaries with ESRD are Medicare enrollees (Medicare beneficiaries,” 2021). Center for Medicare and Medicaid Services (CMS) data shows that currently, 25% of the ESRD population on Medicare have coverage through a Medicare Advantage (M.A.) plan. Also, it has been projected that an additional 83,000 people with ESRD will enroll in MA by 2026, which represents an increase of 63% (America’s Health Insurance Plans [AHIP], 2020). The service gaps in Hawaii should get more concentration from the stakeholders as official statistics show that the life expectancy of patients with ESRD in this state is one of the highest (89%) (Schold et al., 2018).
The factor of a good understanding of the enrollment period plays a significant role in providing care to the patients. As social work students, we are deeply concerned about public health issues. Our major objective was to present a plan to inform Medicare recipients with End-Stage Renal Disease (ESRD) in Hawaii and beyond about their enrollment period, eligibility, coverage and connect them with the resources. We understand that these people are highly vulnerable and are challenged by diverse factors to have access and benefits of Medicare to treat their ESRD diseases. To inform them of the service and its process by establishing a productive informational mechanism can help broaden their knowledge of Medicare. Thus, creating a way to disseminate the information along with collaboration with the Hawaii SHIP is a potentially effective way to address the current enrollment gaps.
As a team, we wanted to accomplish the following goals with regards to our specified population:
- To analyze the prevalence and Medicare gaps for the patient with ESRD.
- To inform Medicare beneficiaries in Hawai’i and beyond about eligibility, enrollment, coverage, and resources regarding ESRD through and auditory deliverables.
- To establish communication with community partners to develop ideas of the best places to disseminate information.
Design and Planning
As a team, we followed our Service-Learning Project Plan proposal that we collaborated on together at the beginning of the semester. Our plan was drafted into four project phases. During Phase 1, “Research/Needs Assessment,” each team member conducted their own research to identify the gaps and limitations for Medicare beneficiaries, resources, and methods of accessibilities for older adults. It was during Phase 1 that we narrowed our focus and our target population to ESRD recipients. As we expanded our knowledge on Medicare, we have learned that the Medicare process works differently for this population. We then furthered our research by reviewing the process for Medicare eligibility and enrollment for ESRD recipients, the interrelationship between diabetes, chronic and ESRD, nationwide and state statistics.
During Phase 2, “Development,” we began to collaborate on developing our product. With a narrowed focus, the goal of our product was to educate and inform ESRD recipients and/or their family members about the Medicare process with a 5-minute animation video. We decided to create our script based on the introduction of ESRD, eligibility, and enrollment for ESRD recipients. Each team member was assigned one component and was responsible for providing concise information for the intended audience. This was conducted in 2-consecutive drafts, reviewed, and edited as a whole team. Once our draft was finalized, the script was submitted for production. The process of a whiteboard animation video took approximately less than a week. We then reviewed our first draft of the video, and a few minor edits were made.
Next, we transitioned into Phase 3, “Implementation.” Our goal was to distribute our product to our community partnership, U.S. Renal Care, but with the unfortunate amount of time left, we were unable to do so. It was one of the limitations of our project. However, with our final presentation of our Service Learning Project to Hawaii SHIP volunteer buddies, we were able to introduce our product to them. This led to our Phase 4, “Evaluation” phase, as we were able to begin writing our evaluation report by using their suggestions and constructive feedback after the presentation. In addition, this will also be used to make necessary changes to our product.
As mentioned, we identified our community during Phase 1, “Research/Needs Assessment.” Our intent to reach the community was through the University of Hawaii partnership with the National Kidney Foundation of Hawaii and the U.S. Renal Care support group. A scheduled meeting with the U.S. Renal Care support group was still being arranged. However, it was proposed our product would still be forwarded to this organization after the semester was finished.
Design of the Whiteboard Animation Video
Animated video is an essential component of many modern organizations, making their activities more engaging and exciting. Since human beings comprehend information through visual and auditory processing faster, creating Whiteboard Animation simplifies the learning process. Whiteboard Animation is a video generated with animated drawings on a white background (Wijayatiningsih, 2019). Various software for Whiteboard Animated Video creation is available on the market. For example, Videoscribe-Sparkol is popular software that creates animated videos by combining pictures and sounds (Wijayatiningsih, 2019). It is a multifunctional service that provides users with a unique image and music combination to make a compelling animation. Producing a Whiteboard Animation video involves seven steps which are creating a storyline, preparing content, installing the software, uploading the visual content, including voice-over, music, and publication of animation.
There are seven steps to make a Whiteboard Animation with the Videoscribe-Sparkol software. The first step is storyline generation for the video to have a specific plan on the general flow of the presented material (Wijayatiningsih, 2019). The second step requires preparing visual and audio content for animation (Wijayatiningsih, 2019). Third, the software needs to be downloaded and installed on the computer. Fourth, visual assets should be uploaded to the installed Videoscribe-Sparkol software (Wijayatiningsih, 2019). The fifth and sixth steps are concerned with voice-over generation and choosing appropriate music for the video (Wijayatiningsih, 2019). Finally, the video created with this software can be published offline or online. This software can be used to make videos on any topic, ensuring its usability for a broad audience.
Whiteboard Animation videos create an attractive and straightforward presentation of information, enabling more effective learning and teaching. The Videoscribe-Sparkol software is a popular tool for combining images and sounds to generate an engaging storyline for any topic following seven easy steps. This software helps to create captivating Whiteboard Animations for users from many different fields. Overall, animated videos substantially contributed to education, business, and non-profit organizations’ activity by making their content more visual, enabling people to grasp information better.
The designed video is intended to be a Medicare resource tool for ESRD individuals and their family members. The video has covered information related to the needs and challenges of the targeted group, their Medicare eligibility, enrollment, signup process, coverage for different parts, and treatment options. Also, in our product, we included a list of important resources for the patient, their families, and stakeholders. The entire service-learning project was accomplished in 4 phases. Research/needs assessment was the first phase, and we conducted thorough research on ESRD individuals and the challenges that they face navigating the Medicare system. These research efforts helped us to understand the problem and prevalence, need assessments, and ultimately determine our ways of interventions. The product development was the second phase, where we distributed the tasks among team members. Primarily we developed a script for the video. We received continuous mentoring from our professors, mentors, and peers. We had support from the community organizations like Hawaii SHIP and National Kidney Foundation. For the evaluation, we received feedback from the peers, professors, mentors, Hawaii SHIP volunteers, and staff and updated it accordingly.
Our theory behind our Service Learning Project is to reduce the overwhelming information on the Medicare process for ESRD recipients through our objectives. This project will impact our community as it will be designed to educate, provide simplified information, and increase awareness for ESRD individuals and their families on Medicare. To facilitate the dissemination, we have plans to distribute it to the stakeholders. Also, by using the existing YouTube account of Hawaii SHIP, we plan to upload it and make it accessible for a larger audience.
Medicare is a federal healthcare program covering people older than sixty-five, individuals with the ESRD that require dialysis for survival, and indeed young people with incapacitating disabilities (Neuman & Jacobson, 2018). The healthcare program has three parts, namely part A, B, and C. In the group project, we realized that part A covers inpatient care, nursing homes, hospice care, and home care facilities. Part B covers physician care and visits, outpatient services, preventive services, and medical supplies, while part C covers drugs and prescriptions (Butler, 2020). We realized that for one to be eligible for the program, they must be equal or older than sixty-five years with the ESRD and have enough history of work probability and retirement to qualify for social security retirement or social security disability insurance (SSDI).
We also noted that one could get the benefits through their parents or their spouse’s work history. To be enrolled, they should visit the Social security service and the dialysis center to send documentation of the patient’s treatment requirements if one has the age or disability cover before developing ESRD. Medicare cover starts the first day of the four months of dialysis plan (Centers for Medicare & Medicaid Services (CMS), 2018). Medicare covers most ESRD bills such as inpatient hospital dialysis, kidney transplants, home dialysis, medication related to the condition, outpatient dialysis from an inpatient certified hospital, and medical advice.
There are two choices for the coordination of benefits. If one had Medicare first before becoming eligible by age and any group health coverage, they pay for the first three days, and after, the Medicare covers them. If one enrolls in ESRD Medicare before registering for the usual Medicare cover, they also undergo a coordination period of 30 days. Medicare ESRD members get advantages such as joining special needs groups so long as the group serves the people with special needs. One can join if one fits the category group; however, there are no special groups in Hawaii (Charles, 2021). The department of health partners with Medicare offers health coverage for the aged, people with disabilities, and ESRD. Through the health insurance office, we understood that the department gives a guideline on establishing an ESRD facility. Such facilities must go to the public hearing process.
The department also offers the Medicare enrollment forms and ensures that beneficiaries are well taken care of in these regards. The aging executive office is under the Department of Health (Oh, 2017). It is a lead agency in the coordination of the aging systems and Hawaii’s support services as per its authorization in state and federal laws. It oversees various programs such as the Senior Medicare Patrol (SMP) in Hawaii, Hawaii State Health insurance assistance program (SHIP), the long-term care ombudsman program (LTCOP), and the healthy aging partnership (State of Hawaii Department of Health [SHDH], 2021). They all handle insurance-related procedures for the aged and people with disabilities.
The federal government funds the health insurance program and ensures to assist the Medicare beneficiaries, caregivers, and families. In the project’s implementation, we found that the department is under the Executive Office of aging. It also serves the soon-to-be retirees. It has certified counselors who help with the Medicare Advantage and other programs that suit the individual beneficiaries’ needs. The wing also refers to an individual for community services (SHDH, 2021). It was great to find out that it is at this point when social workers help beneficiaries access the community resources and enable them to make informed Medicare choices.
Lessons Learned from the Implementation of the Project
We have had a great opportunity this semester, learning from the professionals during class as we developed a better understanding of what Medicare is and the best ways for beneficiaries to manage it. We have been lucky to receive information, feedback, and help from different professionals during the semester. The advice and mentorship helped us as a group in deciding which area we would focus on, this is how we arrived at the topic of End-stage Renal Disease (ESRD). Great brainstorming sessions within the group helped us understand and come up with the areas which would be best to address. Through this document, we are able to express our experiences from the formulation of the project to the implementation stage.
From the project, we learned that end-stage renal disease (ESRD) is a medical condition where an individual’s kidneys are irreversibly damaged, and the kidney ceases to function. It is the last stage of chronic kidney disease. It was discovered that as professionals and social workers, we must understand the organizations and the insurance cover for Medicare to ensure we share adequate information. We learned to engage the community in talks regarding their healthcare needs, and this helped us realize that we can be good community advocates as well as effectively implement successful community projects.
For the community, it was noted the knowledge gap about what insurance covers and various services offered by the Department of Health. Encouraging individuals eligible for coverage to utilize it for improved quality of life and increase survival chances. Some of this information is not common knowledge. Eligibility is one of the most important topics when speaking of ESRD, mainly because there are some decisions that could impact future coverage after a certain age.
As a team, we were inspired by our growing ability to apply practical skills and public health skills in realizing the advocacy and evaluation of the social health determinants in Medicare beneficiaries’ classes (Koprowska, 2020). Also, the collaborations gave us a sense of fulfillment and the courage to approach the ESRD Medicare topic with confidence. The hands-on community engagement was also a source of inspiration, meeting with diverse organizations. We gained an understanding of the role of SHIP counselors in the program.
Accomplishment and Community Impacts
Teamwork and communication skills were developed during the interaction with the counselors and online video learning during classes and presentations. A better understanding of enrollment and coverage within the Medicare system was developed, as well as the choices of the beneficiaries. We also improved the community participation and advocacy skills in the project implementation.
We came into the course with little to no background on Medicare. We have received and increased knowledge on eligibility, coverage, and all aspects of ESRD within the Medicare system. Communication, time management, and the increased teamwork ability developed at a high level during our roles as players in community engagement. We are grateful for the growth and realization of the importance of human relationships, integrity, social justice, competence, and service in dealing with the cover classes’ partners and beneficiaries. Interactions with the teams, counselors, and other organizations created a friendly environment. We feel empowered beyond the social determination of the health needs as a social worker to partnerships, advocacy, and mobilization of community resources.
Furthermore, we were empowered to link the vulnerable communities and groups to the organization to help with their needs. Studies have mentioned the unique role of a social worker in improving people’s lives, maintaining professional relationships, and acting as guides and advocates in the care (Lee, 2020). We are proud to have undergone the program. It has empowered and extensively brought insight into social work’s broad nature and serves as a reminder to be open-minded. Through group discussions and explanations in the video sessions, we understood the earlier perceived complex concepts into simple ones. We also learned how to share responsibilities which simplifies the complex tasks. For instance, in the presentation delivery, we would discuss and prepare the demonstration as a group and then choose one person to represent the rest of us in the arrangement.
Lastly, we take pride in the group members and the instructors for the project implementation’s vast encouragement and teamwork. We, as well as the community, understand the importance of information in making decisions regarding their health care needs. There has been an even deeper integration of openness, and positive health-seeking behaviors, through understanding the specifics of the Medicare system, especially on the topic of ESRD.
Areas of Improvements, Unexpected Experiences, and Barriers
In the project’s implementation, we were able to practice public speaking and team-building actions, the partnership grew our communication skills. We interacted with the SHIP counselors, learned, along with the community about the insurance covers, and made choices regarding their Medicare cover. We effectively communicated among ourselves and the groupmates and cultivated professional relationships with the partnering organizations. A good aspect was also noticing us improve time management skills.
The overall timekeeping was tracked smartly. That action is one worth emulating and integrating into our individual daily schedules. We will use this skill, along with other skills, during our career. As far as the course is concerned, there are no gaps that were noted, especially in the delivery of the course content and the implementation of the community program. The course itself could be broken down into two courses in the future.
We were happy by how the SHIP counselors were willing to walk with us throughout the course and their willingness to teach us. The course showed a conducive environment for learning, utilizing awesome activities, smartly utilizing today’s technology. Different online platforms used kept us engaged. It is lovely to interact with professionals in an environment where the subject matter experts are willing and able to help students achieve the highest levels of learning that were accomplished during this semester. We experienced some challenges in balancing the demands of different classes throughout the semester. While we had different courses on top of this course, we were able to create a balance and found time for meetings.
How the Course Changed our Thinking and Future Persuasion
The course has augmented our thinking on different paths regarding Medicare. Each one of the team members has improved knowledge regarding SHIP and Medicare coverage. Our topic of ESRD helped increase personal knowledge. We understand our role in informing the community on the Medicare coverage to cater to their health needs.
We resolved to look out for the resources such as assistance programs, State programs, and helping organizations which are there for the benefit of the community. We have better knowledge on how to volunteer in Hawaii in programs to render services to the community and practice the skills and knowledge acquired throughout the course. Deciding to be part of the community through disseminating information on Medicare and how programs offered can be utilized at the Departed of Health, and the EOA empowers all involved.
Why the Course Should be Taken next Year to the Graduates and Undergraduates
The course should be offered to the undergraduate, and we are indeed grateful and lucky to have been selected as the pilot students in this program this second time the course is being offered. Vast learning opportunities are offered. The remarkable interactions, counselors, volunteers, and different organizations have made our semester outstanding and exceptional. That kind of atmosphere would also help undergraduates and will expose new students to ways of helping the community through disseminating knowledge. The system will benefit both the graduate and the undergraduates because it will change their views about Medicare, or at the very minimum, increase it.
It will also offer volunteering activities for the students as well as potentially interesting areas of studies and work for the future. The course will enhance their interactive activities, time planning, and communication skills. It will improve knowledge of the various roles within the system and the roles and as well as opportunities of beneficiaries. It will also enhance standards of practice and professionalism.
There are multiple benefits in studying this course for both graduates and undergraduates. It promotes active community participation in Medicare learning and dissemination of information. Engagement in this course benefited the community and us through increasing knowledge about Medicare.
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